What's in the Cass Report?

What’s in the Cass Report?
The final report of the Cass Review of gender-affirming care for youth is being taken as vindication from anti-trans activists.

by Evan Urquhart
Apr 15

In 2020, in the UK, in an atmosphere of increasing political anger and animosity directed at the transgender community, pediatrician Hilary Cass was tasked with reviewing the state of gender-affirming care for youth by the NHS. The Final Report of the Cass Review, released on April 9th, is a 388-page document that almost immediately became the center of gravity in the ongoing political debate about how and whether to treat young people with gender dysphoria. The Report made international news and has been taken as vindication by many anti-trans activists.

A document that approaches four hundred pages will be difficult for most people to read in full, meaning that inevitably most of the public will be forced to rely on summaries provided by journalists, commentators, activists, and others. This article seeks to provide a brief but comprehensive summary for Assigned Media’s audience.

The Cass Review vs the Cass Report

Dr. Cass served as the chair of the independent Cass Review and, for four years, sought data and information pertaining to the treatment of gender diverse children and adolescents in the NHS. While it is clear that others collaborated with Cass, and at least one member of the advisory board has been identified, it remains unclear who the board consisted of.

The Review comissioned a series of studies from the University of York, in England. These included systematic reviews of the evidence on treatments for gender dysphoria in youth, a survey of European youth gender clinics, an investigation of treatment guidelines, a quantitative study of the youth seen by the GIDS clinic in England, and a qualitative study of young people, parents, and clinicians’ attitudes and thoughts on treatment. The Report relies in part on this material, although it includes many other sources of information and in some places lapses into speculation with no clear evidentiary basis.

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Response to the Cass Review

Response to the Cass Review
by Dr Hane Maung | Apr 12, 2024 | News, Trans Youth

Background
Over the past decade, the United Kingdom has become an increasingly hostile place for trans people, especially for trans youth (Hines, 2020; Horton, 2024; McLean, 2021). In addition to vilification by the mainstream media and attempts by politicians to curb the rights of trans people, gender affirming healthcare for trans youth has been severely restricted. In the context of this hostile political environment, NHS England commissioned an independent review into gender affirming healthcare services for trans youth, led by Dr Hilary Cass. On 10th April 2024, the Cass Review published its Independent Review of Gender Identity Services for Children and Young People: Final Report. This present article shows that many of the claims and recommendations of the Cass Review are inaccurate, empirically unsupported, ethically unacceptable, and grounded in cisheteronormative prejudice.

“Through its cisheteronormative agenda, the Cass Review is enacting the prejudice that trans people suffer in the United Kingdom”

The Evidence Base
At the outset, it is important to note that the Cass Review did not produce any new data. Rather, it reviewed data from previous studies on the effects of gender affirming medical treatment for trans youth.

However, review of the literature was profoundly inadequate. Notably, the Cass Review dismisses a very large number of studies and omits studies from the past two years. Hence, it neglects a vast amount of evidence on the benefits of gender affirming medical treatment for trans youth in its analysis.

The reason for dismissing this evidence is that it did not come from randomised controlled trials. However, this indicates a serious misunderstanding of the roles and limitations of randomised controlled trials compared with other sources of evidence.

[…]

ANALYSIS: The Cass Review heralds how all trans medicine will die

ANALYSIS: The Cass Review heralds how all trans medicine will die
In effect, the study research completely blew off the input of the people most affected by access to treatment
Published 1 day ago on April 15, 2024 By Brynn Tannehill, FAIRFAX, Va.

By Brynn Tannehill | FAIRFAX, Va. – This past week, the Cass literature review for the UK’s National Health Service for transgender youth was completed after four years in development. Although touted as independent, it was anything but. Dr. Hillary Cass consulted with far-right religious anti-trans activists like Patrick Hunter, and took cues on how to ban trans health care from Florida’s rigged process.

The results were predictable: it effectively recommends banning transition related care for anyone under the age of 25. Because of backlogs in the NHS system, this means that transgender people cannot even begin applying for care until they are 25 and will likely have to wait until they are 35, even if they have had a transgender identity since an early age. It also recommends a ban on social transitions, and any sort of social affirmation.

[…]

You might think, “Oh, this is just the United Kingdom,” and that it doesn’t affect you. But it does. We have concrete evidence that Cass was coordinating with Ron DeSantis appointees, who in turn were selected for their religious fervor and connections with anti-LGBTQ+ hate groups in the US like the Alliance Defending Freedom. The Cass review illustrates how they are planning to end access to transgender health care for all adults in the US.

Basically, the process is to get a decision-making body (like the FDA) to commission a “review” of the evidence for health care for trans adults. The reviewers will be people who already know the outcome they want and who are only interested in p-hacking their way to a non-conclusion. The formula looks like this:

Do a lit review.
Find filters that excludes all of the evidence in support of health care for trans people (i.e. requiring RCT and double-blind for inclusion).
Declare that there is no evidence for transition related care.
Recommend “neutral” interventions like talk therapy, when there’s no evidence this works.
The FDA or state medical boards use the phony lit review to justify bans on the use of any off-label treatments for gender dysphoria, along with any gender confirmation surgeries.
With the death of Roe v. Wade, this is entirely legal. SCOTUS won’t stop it; they’re likely to uphold the decision-making authority of supposedly neutral medical authorities, and the lit reviews commissioned by them. If Trump is elected, this will happen nation-wide. If he isn’t, we’re going to see roughly 25 states eventually ban health care for trans adults the way they did to trans youth.

[…]

Trans activists outraged over major study questioning the benefits of gender-affirming care

Trans activists outraged over major study questioning the benefits of gender-affirming care
The Cass Review flies in the face of most American medical guidance, and activists are terrified of the repercussions.
By Daniel Villarreal Thursday, April 11, 2024
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Transgender advocates are incensed over an independent 400-page review of medical research on gender-affirming care for youth that claims there is not enough data to conclude gender-affirming care is good for trans kids.

[...]

Transgender advocate Julia Serano wrote that the Cass review excluded over 100 medical studies and literature reviews that show gender-affirming care to be effective.

Trans activist Allison Chapman, along with many others, accused the review of excluding studies on hormone replacement therapy and puberty blockers “solely because” the studies weren’t “blind” — that is, they informed researchers which participants were receiving both treatments rather than letting them evaluate the outcomes without that knowledge. Excluding those studies is “bad science and transphobic,” Chapman wrote.

Reed also noted that Cass dismissed the studies for using standards “that are unattainable and not required of most other pediatric medicine.”

https://twitter.com/AlliRaine22/status/1777781496780112018
{SHITTER ALTERNATIVE LINK:}
https://www.threads.net/@alliraine22/post/C5jXU93gOqw
{/SHITTER SUCKS}

https://twitter.com/JuliaSerano/status/1777754949105188874
{SHITTER ALTERNATIVE LINKS:}
https://bsky.app/profile/peebeejaybee.bsky.social/post/3kpsgyg7i5w2q
https://juliaserano.medium.com/gender-affirming-care-for-trans-youth-is-neither-new-nor-experimental-a-timeline-and-compilation-b4bb8375d797
{/SHITTER SUCKS}

[...]

Chapman slammed Cass for a statement to The Guardian pushing the above “social contagion” theory, in which Cass said social media may be causing more kids to think they’re trans. “Absolutely absurd statement that is not backed in facts, or studies,” Chapman said. “This is clearly a biased review that was driven by transphobic opinions and not facts.”

https://twitter.com/AlliRaine22/status/1778136741305565463
{SHITTER ALTERNATIVE LINK}
https://www.threads.net/@alliraine22/post/C5l5QFsJ4ai
{/SHITTER SUCKS}

[...]

“The focus on the use of puberty blockers for managing gender-related distress has overshadowed the possibility that other evidence-based treatments may be more effective,” the review said, noting that other interventions are not the same as “conversion therapy” that seeks to change people’s gender identity from trans to cisgender.

“The intent of psychosocial intervention is not to change the person’s perception of who they are, but to work with them to explore their concerns and experiences and help alleviate their distress regardless of whether or not the young person subsequently proceeds on a medical pathway,” the review stated, recommending “a much more holistic offer of care.”

Activist Adi Aliza called these recommendations “terrifying.”

https://twitter.com/Adi_Aliza_DG/status/1778061064195751992th
{NO ALTERNATIVE TO SHITTER LINK ABOVE}
[...]

Cass Met With DeSantis Pick Over Trans Ban: Her Review Now Targets England Trans Care

Cass Met With DeSantis Pick Over Trans Ban: Her Review Now Targets England Trans Care
ERIN REED
APR 10, 2024



On Tuesday evening, Dr. Hilary Cass released a final report commissioned by the NHS, widely expected to target gender-affirming care. The report met these expectations, calling for restrictions on gender-affirming care and social transition, and even advocated for blocking transgender adults under the age of 25 from entering adult care. To justify these recommendations, the review dismissed over 100 studies on the efficacy of transgender care as not suitably high quality, applying standards that are unattainable and not required of most other pediatric medicine. Conducted in a manner similar to the anti-trans review by the DeSantis-handpicked Board of Medicine in Florida, which Cass reportedly collaborated on, the report and its reviews are likely to underpin further crackdowns on trans care globally.

The 388-page report featured 32 recommendations on how transgender care should be conducted within NHS England. It incorrectly claims that there is “no good evidence” supporting transgender care and calls for restrictions on trans care for individuals under the age of 18, although it does not advocate for an outright ban. The report endorses the idea that being transgender may be caused by anxiety, depression, and OCD issues, despite the American Psychological Association, the largest psychological association in the world, rebutting this as lacking evidence. It also claims that transgender individuals can be “influenced” into being trans, a nod to the discredited theory of social contagion and rapid onset gender dysphoria, rejected by over 60 mental health organizations. Lastly, it seemingly endorses restrictions on transgender people under the age of 25, stating that they should not be allowed to progress into adult care clinics.

To support these recommendations, the report was released alongside “reviews” of the evidence surrounding transgender care, using these reviews to assert that there is "no good evidence" for gender-affirming care. A closer inspection of the reviews released alongside the Cass report reveals that 101 out of 103 studies on gender-affirming care were dismissed for not being of "sufficiently high quality," based on the Newcastle-Ottawa Scale—a subjective scale criticized for its flaws and potential unreliability due to a high risk of bias. This critique is particularly significant given the contentious political nature of the subject and connections between reviewers, Cass, and anti-trans organizations.

The Cass Review seems to have emulated the Florida Review, which employed a similar method to justify bans on trans care in the state—a process criticized as politically motivated by the Human Rights Campaign. Notably, Hilary Cass met with Patrick Hunter, a member of the anti-trans Catholic Medical Association who played a significant role in the development of the Florida Review and Standards of Care under Republican Governor Ron DeSantis. Patrick Hunter was chosen specifically by the governor, who has exhibited fierce opposition towards LGBTQ+ and especially transgender people, and then immediately got to work on targeting transgender care. The Florida review was purportedly designed and manipulated with the intention of having "care effectively banned" from the outset, as revealed by court documents. The Florida Review was slammed by Yale Researchers as “not a serious scientific analysis, but rather, a document crafted to serve a political agenda,” and much of their full critique is applicable to the Cass Review as well.

[...]

Fact Check: No, A New Study Does Not Show "Being Trans Is Just A Phase"

Fact Check: No, A New Study Does Not Show "Being Trans Is Just A Phase"

ERIN REED
APR 05, 2024



On Thursday, the Daily Mail reported that a new "landmark study" from the Netherlands concluded that being transgender was "just a phase" and that most children "grow out of it." News of the study was widely reported on Twitter by conservative accounts, with tweets about the Daily Mail’s reporting of the study garnering tens of millions of views. Unfortunately, the headline fails a fact check: the study was not about transgender individuals, but rather on people who sometimes express dissatisfaction with their sex for a variety of reasons entirely unrelated to being transgender.

The Claims:

The study to which the Daily Mail refers was published in the Archives of Sexual Behavior. This journal, under the leadership of Kenneth Zucker, a noted anti-trans figure known for his involvement in reparative/conversion therapy, has become a parking journal for anti-transgender research. The study aims to examine a single question from 15 years of surveys administered to 2,772 children in the Netherlands who transitioned into adulthood: "I wish I were the opposite sex." Respondents were asked to indicate their feelings by circling 0 for "never," 1 for "sometimes," and 2 for "often." A copy of the question can be viewed here:

[…]

The Problems:

There are immediate issues with both the study and the Daily Mail’s interpretation of it. The most evident issue with the study is that it is not a study of transgender individuals; this should be apparent considering that a full 19% of participants indicated "sometimes" or "often" in response to wanting to be the opposite sex at some point in their lives, with the majority selecting "sometimes." Even the most generous estimates suggest that approximately 0.5% of Americans identify as transgender. It is clear that the authors are measuring an entirely different population by analyzing responses to this single question.

It is easy to see how various individuals might respond "sometimes" (which includes rarely) or "often" to this question. Tomboys, feminine gay teen boys, gender nonconforming individuals, people who experience sexism, and even those with curious minds might answer affirmatively without ever identifying as transgender. If someone has ever momentarily wished to be the opposite sex, for any reason, even in passing, they would be categorized as "gender noncontent." Should that individual later state when older that they no longer ever experience this desire, they would then be classified as experiencing "decreasing" gender noncontentedness.

Of course, transgender identification is not accurately gauged by answering a single question. Instead, gender dysphoria diagnoses require a persistent, consistent, and insistent desire to be the other sex lasting 6 months, as well as 5 of 7 other criteria, such as a dislike of one’s own sexual anatomy, a desire for sex characteristics to match their experienced gender, preference for cross sex roles in make-believe play, and more. The study, on the other hand, looks at an isolated question at individual moments in young people’s lives and clearly cannot be used as a proxy for transgender people.

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GROUP DYNAMICS AND DIVISION OF LABOR WITHIN THE ANTI-LGBTQ+ PSEUDOSCIENCE NETWORK

GROUP DYNAMICS AND DIVISION OF LABOR WITHIN THE ANTI-LGBTQ+ PSEUDOSCIENCE NETWORK
December 12, 2023
In this article

Defining the Pseudoscience Network
Division of Labor in the Pseudoscience Network
A New Orthodoxy
The Funding

Before the campaign to end gender-affirming care, anti-LGBTQ+ pseudoscience was cultivated and disseminated in campaigns to discourage funding for HIV/AIDS programs, limit access to comprehensive sex education curricula, prevent marriage equality and recognition of LGBTQ+ families, institute and maintain the U.S. military’s ban on openly gay and lesbian troops known as “don’t ask, don’t tell,” defend the conversion therapy industry, and attack gender identity protections in public schools.

Anti-LGBTQ+ pseudoscience must also be understood as part of the historical legacy of white supremacy and the political aims of the religious right. First, as we detail in Chapter 1, pseudoscience has been wielded by white supremacists and eugenicists to substantiate false claims about their racial superiority for centuries. A component of that mythical racial superiority has always been a supposed sexual purity – the idea that sexual immorality dilutes white power. Pseudoscientific justifications for pathologizing LGBTQ+ identities, then, help “diagnose” and “cure” threats to whiteness, specifically threats to the perpetuation of the so-called white race through the heteronormative white family.

Secondly, 20th and 21st century anti-LGBTQ+ pseudoscience emerged from a movement to provide scientific justification for the political priorities of conservative Christians. Proponents of anti-LGBTQ+ pseudoscience cannot divorce it from the white Christian nationalist political movement that seeks to tear down the separation of church and state and ultimately encode their conservative interpretation of Christian scripture into American law. There are numerous examples of this throughout American history, including:

The creationist and intelligent design movements that encourage public schools to undermine the scientific consensus of evolutionary biology by “teaching the controversy” of creationism cloaked in the rhetoric of so-called intelligent design. Contemporary anti-LGBTQ+ pseudoscience draws heavily on the essentialist “biblical binary” notion of male and female sex and gender “complementarity.”[1]
The anti-abortion movement and opponents of stem cell research, who share organizational and philosophical ties to the anti-LGBTQ+ pseudoscientific movement, and similarly seek to replace medical science with conservative religious policy positions.[2]
The climate denial movement, which, at its most extreme, draws a connection between a millenarian theology and disregard for the climate crisis, but also borrows from the creationist movement in seeking to undermine scientific consensus about the history and causes of global climate change.[3]
As the most prominent research topics fluctuate over time, each iteration of this pseudoscientific industry overlaps with the next. The institutions established to wage war on secular science in previous decades pass on their knowledge, networks, and organizational strategies to their ideological progeny.

[…]

To those lgbt DUers who celebrate Easter

March 31st- Assigned Male Comics

Outrage after Oklahoma prosecutor declines charges in Nex Benedict bullying death

Outrage after Oklahoma prosecutor declines charges in Nex Benedict bullying death
Adocates and community members are outraged that Stephen Kunzweiler, the Tulsa County district attorney, has decided not to pursue criminal charges in the death of the transgender teen.
CHRISTOPHER WIGGINS
MARCH 22 2024 5:21 PM EST

After Tulsa County District Attorney Stephen Kunzweiler’s decision Thursday not to file charges in the death of Nex Benedict, a 16-year-old transgender and Indigenous high school student from Oklahoma who used he, him, they, and them pronouns, a storm of advocacy and criticism has emerged from LGBTQ+ groups and community members. This wave of condemnation targets both Kunzweiler’s specific handling of the case and the broader systemic implications for the protection of LGBTQ+ youth. At the heart of the outcry are Kunzweiler’s assertions based on the medical examiner’s ruling of suicide and his own characterization of a preceding altercation as “mutual combat,” which have ignited a broader debate about systemic failures in safeguarding marginalized youth.

Sarah Kate Ellis, president and CEO of GLAAD, was among the first to voice dissent, highlighting the decision as indicative of a systemic devaluation of the lives of Indigenous and LGBTQ+ students in Oklahoma. “Time and time again, leaders in Oklahoma have showed that they don’t value Nex’s life, or the lives of other Indigenous and 2STGNC+ (Two Spirit, transgender, gender-noncoforming+) students. Everyone from Superintendent [Ryan] Walters and Owasso High School to the unaccredited-since-2009 state Medical Examiner’s Office, the District Attorney, and Owasso Police Department have failed Nex Benedict and failed us all,” Ellis said in a statement.

“It is critical that an independent investigation is completed and the truth about what happened to Nex, and what all marginalized youth in Oklahoma schools endure, is brought to light. We will never stop seeking justice for Nex and we will never stop holding leaders accountable to serving their communities fairly and with compassion,” she said.

GLAAD officials also said that Kunzweiler’s decision was based on incomplete and inaccurate information.

Adding to the criticism, Freedom Oklahoma condemned Kunzweiler’s use of Benedict’s deadname, a practice Nicole McAfee, Freedom Oklahoma’s executive director, described as emblematic of a justice system failing to protect the dignity of transgender, Two-Spirit, and gender-nonconforming people.

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